NCC191304_NOI Application_20190812

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/9/2019 8:28:27 AM (NCG01 NOI Submission)
Approve by Georgoulias, Bethany 8/9/2019 8:58:34 AM (Review- Construction NOI 14675)
* The NOI Certification uploaded in this re -submittal did not have all acknowledgement boxes checked;
however, the original submittal did. The reviewer will add the original certification form to the final COC file
once issued.
• Georgoulias, Bethany reassigned the task to Georgoulias, Bethany 8/9/2019 8:40 AM
• The task was assigned to Lucas, Annette by round robin distribution 8/9/2019 8:28 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 13, 2019 5:00
PM 8/9/2019 8:28 AM
Submit by Lucas, Annette 8/12/2019 9:11:32 AM (Payment Verification for NCC191304)
• Lucas, Annette assigned the task to Lucas, Annette 8/12/2019 9:11 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 23, 2019 5:00 PM
8/9/2019 8:58 AM

! 1i) iTII1T 2,G) M Fill (-:TiI a 1010
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Foschetti Residence
2. County* McDowell
3. Highway or Street Buck Creek Road
Address * Street name only is acceptable if no address number assigned yet
4. City or Township* Marion
5. State * NC
6. Zip Code* 28752
7. Latitude * Enter the latitude in decimal degrees
35.7431
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-82.1469
If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of
North Carolina. Look for the coordinates in the bottom left corner.
9. Date to Begin*
11/01/2018
Estimated Construction Project Start Date
10. Date to End*
08/31 /2019
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
3.13
disturbed*
(including off -site borrow and waste areas)
13. Total site area 9.88
(acres)*
14. Post- 0.45
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-MCDOW-2018-Foschetti Residence
Tracking ID Assigned autorratically
Below you must enter waterbody information for surface waters affected by this project. Please consult
DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. You may
enter up to 3 waterbodies.
15a. Receiving Buck Creek
Wate rbody* Nacre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 11-19-(1)
Index No. * NCWaterbody Index N nber
Stormwater fJ No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act? *

B. Permittee Information
Part B.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form should be the same person as listed in THIS SECTION, or an authorized responsible individual within the same
organization. That person must be a responsible corporate officer who owns or operates the construction activity, such
as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV,
Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Organization Michael Foschetti
Name *
2. First Name* Michael
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Foschetti
ff Corporation, enter Registered Agent Last Barre
3b. Title Property Owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 3472161472
Telephone No.*
6. Permittee Mailing Street Address
Address* 7024 Tomlin Green Ln
Address Line 2
City
Charlotte
Postal / Zip Code
28277-8187
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
7024 Tomlin Green Ln
Address Line 2
City
Charlotte
Postal / Zip Code
28277-8187
State / Province / Region
NC
Country
us
State / Province / Region
NC
Country
us

C. Site Contact Information
Part C.
Roiect Site Contact hforrration
1. Type of Individual
Ownership*
2. Primary Site Michael
Contact - First
Name *
3. Primary Site Foschetti
Contact - Last
Name *
4. Title Property Owner
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 3472161472
Telephone No.*
7. Organization
Name
8. Site Contact Street Address
Mailing Address* 7024 Tomlin Green Ln
Address Line 2
aty
Charlotte
Fbstal / Zip Code
28277
State / Rovince / Region
North Carolina
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 08/07/2019
Approved *
2. E&SC Plan Project MCDOW 2019-003
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Asheville (ARO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application.
5. E&SC Plan D00080819-08082019080954.pdf 93.57KB
Approval Mist be FDFforrrat
letter/documentation
6. NOI Certification ACFrOgD1hMoohiuvg54NLbAyJDuG4PgXllxO-
Form 131.31 KB
IcTBz47Uz7dJpRBu6Xmspg3l4dOMOCSeHiX5_Jaq E...
Mist be FDF format
This is an Express f• No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ I am the person responsible for the construction activities of this project, for
satisfying the requirements of this permit, and for any civil or criminal penalties
incurred due to violations of this permit.
* rJ The information submitted in this NOI is, to the best of my knowledge and belief,
true, accurate, and complete based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the
information.
* I7 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* rJ I hereby request coverage under the NCG010000 General Permit and
understand that coverage under this permit will constitute the permit
requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
Specify if you are:* r The Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *An authorized individual is a responsible corporate officer who owns or operates the construction activity,
such as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV,
Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
Signature
A41C4A0L J1'-65Ch'xM
Type Name *
Michael Foschetti
Title
Property Owner
Organization
Michael Foschetti
Date *
08/09/2019

F. Tracking and COC Info
NOI Tracking No. 14675
NC Reference No. NCG01-2019-1304
Uses 'count _nunber'variable (incremrented by SP)
Certificate of NCC191304
Coverage (COC) Uses 'count nunber variable (increrrentedbySP)
No. *
Count Number 1304
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)